Provider Demographics
NPI:1477264836
Name:TAJCHMAN, BRIAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:
Last Name:TAJCHMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5026 DEEPWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-2901
Mailing Address - Country:US
Mailing Address - Phone:361-854-2278
Mailing Address - Fax:
Practice Address - Street 1:1302 E 5TH ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-3944
Practice Address - Country:US
Practice Address - Phone:361-664-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2059726225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant